Common Errors When Beginning A GLP-1

I’ve been taking weight-loss drugs, as in a GLP-1 medication, and am paying for it out of pocket. I’m not taking one of those brand-name pharmaceuticals like Ozempic, Wegovy or Zepbound, although I tried. Late last year, I was told by my doctor’s office that my insurance wouldn’t cover any weight-loss medication, unless perhaps I was fortunate enough to have a stroke or heart attack. (I have a swell insurance company.)

I couldn’t afford the brand-name drugs out of pocket, and my physician didn’t have any weight-loss suggestions beyond the usual “eat less and exercise more” advice, but my brother suggested I see his doctor. My new doctor directed me to a nearby reputable compound pharmacy. (These compound pharmacies are around the country and can make pharmaceutical drugs on the premises.) Since Jan. 11, I’ve been spending $200 a month so that I can inject myself with semaglutide, a type of GLP-1 drug.

Injecting myself in the stomach with medication once a week and occasionally driving 45 minutes out of my way to see this new doctor of mine is not my idea of a good time, but when I started taking it, I was feeling pretty desperate. I was about a week away from my 55th birthday and north of 300 pounds. I was prediabetic and walking down my driveway to get the mail felt like I was hiking the entire Appalachian Trail.

I’ve tried just about everything throughout my adult life to get my weight under control ― the usual “eat less, exercise more” advice that’s so often doled out by doctors was not working. So I figured I’d give GLP-1 medications a shot. I really felt like I had nothing to lose. Well, poor choice of words.

And I did lose almost 35 pounds. My blood sugar levels have improved, and I’m no longer prediabetic. I can now walk to my mailbox without worrying that I might need to call an Uber to get back to my front door. I have a long way to go before anybody would refer to me as completely healthy, and I wouldn’t call myself an expert on semaglutide. And obviously, my experiences won’t necessarily mimic everybody else’s.

Still, maybe I’ve become an expert on what not to do when you take GLP-1 medication. I’ve made my fair share of mistakes. Here’s what to know.

This is my most embarrassing mistake, but I was under the impression that I wouldn’t enjoy eating while taking the medication; I kept reading about diners pushing away their half-filled plates. So a few days before I was scheduled to have my medication delivered, I thought, “I’m going to miss having an appetite. You know, until the GLP-1 arrives, I’m just going to eat whatever I want.”

Unfortunately, there were some delays with getting my medication, and, well, I probably spent about eight days eating whatever I wanted, not focusing on any sort of nutrition. I gained more weight.

The doctor weighs in: Not that you need an expert to tell you what I did isn’t necessarily advised, but let’s do just that.

Tandra Chakraborty, a professor of biology who, among other things, researches obesity at Adelphi University in Garden City, New York, said that “everyone enjoys a little binge eating now and then, and if it’s just for a day or two, it’s usually not a big deal for someone healthy.” However, she warned that “if it goes on longer, it can really set you back.” Binge eating can also become a mental health issue if it affects your daily life.

The goal of a GLP-1 isn’t to entirely eliminate your desire to eat; in fact, most people do generally keep an appetite ― or if it disappears, it should come back once you’ve found the proper dosing with your doctor.

If I had realized that semaglutide might not completely change my appetite, I could have tempered my expectations and avoided disappointment from the get-go.

In fact, for weeks, if not months, I kept wondering if the medication was really working. I did consume less, but my appetite was only slightly diminished. I found myself wondering, “Am I eating less due to the medication, or is this a placebo effect?”

The doctors weigh in: “For GLP drugs, some people may notice results immediately, while others may take longer,” said Chakraborty. “Don’t worry if your appetite doesn’t change immediately after starting the medication. Sometimes, the medicine can influence eating habits in different ways, such as making you less interested in greasy foods or carbs.”

It’s true: Research shows GLP-1s may reduce certain food cravings or addiction. People have also reported a reduction in their desire for alcohol.

Some people don’t experience any side effects, but others might get hit with several. Issues people have encountered include nausea, upset stomach, constipation, hair loss and more. It’s critical that you alert your doctor to anything you might be feeling so they can monitor you along the way. There’s a chance this medication might not be suitable for you, which probably isn’t your fault; it’s just maybe dumb luck and your particular biology.

The doctors weigh in: I’ve suffered very little nausea, but that’s not the case for everyone. Dr. Hector Perez, a board-certified bariatric surgeon at Renew Bariatrics in Tijuana, Mexico, told me that one of his patients started the medication right before his daughter’s wedding, “and spent half the reception nauseous.”

He added, “The lesson is to start low, go slow, and plan your first doses around quiet weekends instead of major life events.”

Everyone’s touted a GLP-1 as a wonder drug, and it certainly can be! But it’s easy to bestow it with more magical powers than it has.

I have been exercising on my treadmill almost every day since I began taking GLP-1, and I started eating fruit twice a day because I keep hearing rumors that it’s a good idea. But otherwise, I didn’t really dramatically change my nutrition habits during the first few months of losing weight, and I suspect I still haven’t modified them enough.

The doctor weighs in: Dr. David Nazarian is an internist in Beverly Hills, and at his practice, My Concierge MD, he has a weight-loss program. Like most doctors, Nazarian said you shouldn’t rely solely on GLP-1 medication to help you lose weight.

“You need to make lifestyle changes that are sustainable,” Nazarian said. “You have to change habits and eat sweets and sugar in moderation.” Incorporating more protein, fiber and healthy fats can help boost your nutritional needs. He also recommends regular exercise, including weight training.

If you make those lifestyle changes, Nazarian said, you’ll develop habits that you can keep after you stop taking the medication, since most people eventually stop. Those improved lifestyle changes, hopefully, will keep you healthy for years to come.

Just know that this medication is a tool, designed to make it easier for people who follow the recommendations we’ve heard about our entire lives ― eat better, exercise more ― but didn’t see the results. With GLP-1s, it’s best to think of weight loss as being easier, not easy. And it might not be linear, or fast and drastic.

A doctor’s take: Perez sees this quite a bit, where patients taking GLP-1s believe that they can lose weight rapidly without any other interventions. But if you know that it may take time and lifestyle changes, the GLP-1 will probably work better for you ― and you may keep the weight loss off if you stop taking the medication. It’s also important, Perez said, to realize that even if you do have incredible weight loss success, there will still be setbacks.

“Weight loss on GLP-1s isn’t linear, and plateaus are normal. It’s common to drop [weight] in three months, then nothing for six weeks,” Perez said. He added that after six weeks, a lot of patients want to quit, “but they should know that plateaus aren’t a failure. It’s just that the body needs to recalibrate from time to time. With small adjustments, including more sleep and better protein intake, you can break through.”

That’s why, frankly, the hype around a GLP-1 is kind of maddening and can work against a lot of us, I suspect. You see those TV commercials for Wegovy, Ozempic and Zepbound, and, sure, they show scenes of actors eating healthy foods and being active, but everybody’s so happy and excited to be losing weight that you miss the fact that while on these medications, you should still prioritize healthy habits. In other words, these weight-loss medications make it easier to lose weight ― but it’s still no piece of cake. And now I want some cake.